Study: Robotic telemedicine in NICU feasible, safe

A remote-controlled, robotic telemedicine system in the neonatal intensive care unit (NICU) is feasible and safe, according to a research published in the May issue of Journal of Perinatology.

The study reports good to excellent agreement, in most areas, when comparing the assessments made by onsite compared with off-site neonatologists controlling the robot from a remote location.

“Telemedicine offers the ability to provide the expertise of specialists and subspecialists at places where their physical presence is not possible. In this way, it shows tremendous potential for improving healthcare delivery and outcomes in a cost-effective manner,” said Philippe Friedlich, MD, MSEpi, MBA at the Center for Fetal and Neonatal Medicine at Children’s Hospital in Los Angeles.

During the past decades, there has been a dramatic rise in the demand for NICUs in the U.S. due to an increase in preterm deliveries, especially late preterm births and multiple births. Also, advances in neonatal medicine have resulted in the improved survival of critically ill newborns. However, most hospitals with lower level NICUs (levels I and II) cannot afford to have in-house, 24-hour staffing by neonatologists.

When an emergency arises in these NICUs, the newborn may be initially cared for by an off-site neonatologist who assesses the patient based on information provided via telephone by the nursing staff. As information relayed via telephone during an emergency may be unreliable, inappropriate treatment and negative patient outcomes can occur. Telemedicine technology can provide the off-site neonatologist with direct visual and auditory information about the patient and the clinical scenario in real-time in order to facilitate decisions about clinical care. In addition, the system could be useful for providing immediate consults for emergencies occurring in a community hospital NICU by subspecialists and neonatologists available 24-hours a day at an associated children’s hospital or large medical center.

This prospective study considered 304 patient encounters on 46 premature and full-term newborns in a level IIIa NICU. During each patient encounter, the infant was evaluated by both an onsite and an off-site neonatologist. The off-site neonatologist evaluated the patient using a wireless, mobile, robotic telecommunications system. The system had bi-directional, real-time audio and video communication capabilities and was linked to a remote-controlled robot equipped with a video camera, microphone, electronic stethoscope, liquid crystal display screen and motorized platform under the control of the off-site neonatologist. The off-site neonatologist controlled the robot through a computer station equipped with a joystick, microphone, earphone and loudspeakers.

The investigators found that the robotic telemedicine system allowed the off-site neonatologist to accurately identify and assess patients and safely maneuver the mobile robot in the NICU. Agreement between the assessments made by the onsite and off-site physicians were good to excellent for most parameters. The parameters that had poor agreement between onsite and off-site physicians were related to certain components of the physical exam. Comparisons between paired onsite physicians also showed poor agreement in these parameters suggesting that these components of the physical exam are inherently subjective and that the lack of agreement was unrelated to the use of technology in performing the assessment.

“The encouraging and novel findings of this study represent the first step in a series of studies needed to be performed before the use of the remote-controlled robotic telemedicine system can be recommended for routine use in community hospitals with or without a link to a children’s hospital or large medical center,” said Istvan Seri, MD, PhD, HonD, director of the Center for Fetal and Neonatal Medicine at Children’s Hospital and senior author on the study. “As we have obtained additional support from the UniHealth Foundation, we have continued our investigations and are now in the process of studying the efficacy and cost-effectiveness of the use of the remote-controlled robotic telemedicine system in the NICU.”